Active NPI
Jennifer Lee Woodson, M.D.
- Family Medicine Physician
- Coronado, CA
National Provider Identifier
1487842654
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- G77861
- Practice address
- 1224 10TH St
Suite 200
Coronado, CA 92118-3416 - Phone
- (619) 435-2234
- Fax
- (619) 435-1784
- NPI assigned
- Oct 12, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | G77861 | CA | Primary |
Addresses
Primary practice location
1224 10TH St
Suite 200
Coronado, CA 92118-3416
Mailing address
1224 10TH St
Suite 200
Coronado, CA 92118-3416
Phone (619) 435-2234
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G77861 | CA | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sharp Coronado Hospital and Healthcare Center | Past | Accepting new patients | |
| Laura Norton Petrovich MD PC | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Pediatrics Physician
- Coronado, CA
- NPI 1033368741
-
- General Acute Care Hospital
- Coronado, CA
- NPI 1154304475
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1192147200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1351555200000",
"number": "1487842654",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1224 10TH ST",
"address_2": "SUITE 200",
"city": "CORONADO",
"state": "CA",
"postal_code": "921183416",
"telephone_number": "619-435-2234",
"fax_number": "619-435-1784"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1224 10TH ST",
"address_2": "SUITE 200",
"city": "CORONADO",
"state": "CA",
"postal_code": "921183416",
"telephone_number": "619-435-2234",
"fax_number": "619-435-1784"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WOODSON",
"first_name": "JENNIFER",
"middle_name": "LEE",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-10-12",
"last_updated": "2012-10-30",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "CA",
"license": "G77861",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Coronado, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.